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The Cost of Opioid Use in High-Risk Hospitalized Infants
Olivia A Keane1, Shadassa Ourshalimian1, Cameron Kaplan2
1Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California.
Insights
Prolonged opioid use in high-risk infants significantly increases healthcare costs and resource utilization. This study quantifies the substantial financial impact of opioid exposure on vulnerable newborns requiring intensive care.
Area of Science:
- Pediatric Healthcare Research
- Neonatal Intensive Care
- Health Economics
Background:
- Hospitalizations for high-risk infants are costly, often involving surgery and intensive care.
- Healthcare costs and resource use for infant opioid exposure are not well understood.
Purpose of the Study:
- To estimate the impact of opioid use on healthcare costs and resource utilization in hospitalized high-risk infants.
Main Methods:
- Retrospective cohort study of 126,897 high-risk infants (<1 year) from 47 children's hospitals (2010-2020).
- Identified high-risk infants using ICD codes for conditions like congenital heart disease, necrotizing enterocolitis, and prematurity.
- Analyzed healthcare resource utilization using standardized unit costs (SUCs) and instrumental variable analysis to assess opioid impact.
Main Results:
- Median SUC per infant was $120,585.
- Each day of opioid use was associated with an increase of $4406 in SUC (instrumental variable analysis).
- Even after adjusting for comorbidities and intensive care, each opioid exposure day increased SUC by $2177.
Conclusions:
- Prolonged opioid use is a significant driver of healthcare utilization and costs in high-risk infants.
- The association persists even when controlling for critical care factors like ventilation and nutrition.
- Further research is needed to determine long-term complications and associated costs of infant opioid exposure.
Introduction:
Hospitalizations of high-risk infants are among the most expensive in the United States, with many requiring surgery and months of intensive care. Healthcare costs and resource use associated with hospitalized infant opioid exposure are less well known.
Methods:
A retrospective cohort of high-risk infants aged <1 y admitted from 47 children's hospitals from 2010 to 2020 was identified from Pediatric Healthcare Information System. High-risk infants were identified by International Classification of Diseases 9/10 codes for congenital heart disease procedures, medical and surgical necrotizing enterocolitis, extremely low birth weight, very low birth weight, hypoxemic ischemic encephalopathy, extracorporeal membrane oxygenation, and gastrointestinal tract malformations. Healthcare resource utilization was estimated using standardized unit costs (SUCs). The impact of opioid use on SUC was examined using general linear models and an instrumental variable.
Results:
Overall, 126,897 high-risk infants were identified. The cohort was majority White (57.1%), non-Hispanic (72.0%), and male (55.4%). Prematurity occurred in 26.4% and a majority underwent surgery (77.9%). Median SUC was $120,585 (interquartile range: $57,602-$276,562) per infant. On instrumental variable analysis, each day of opioid use was associated with an increase of $4406 in SUC. When adjusting for biologic sex, race, ethnicity, insurance type, diagnosis category, number of comorbidities, mechanical ventilation, and total parental nutrition use, each day of opioid use was associated with an increase of $2177 per infant.
Conclusions:
Prolonged opioid use is significantly associated with healthcare utilization and costs for high-risk infants, even when accounting for comorbidities, intensive care, ventilation, and total parental nutrition use. Future studies are needed to estimate the long-term complications and additional costs resulting from prolonged opioid exposures in high-risk infants.
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